Objective of the work is to improve diagnostics of cardiovascular disorders with neonatal sepsis (NS) by means of finding and verification of sepsis-associated myocardial dysfunction (SAMD) based on clinical-paraclinical results of neonatal examination. To achieve the aim and to solve the tasks, 117 neonates were included into the study distributed into two clinical groups. The min group included 87 patients with neonatal sepsis signs. Inclusion criteria to the main group were the age of 0-28 days of neonatal life, perinatal factors of maternal and/or neonatal susceptibility to infectious-inflammatory process, presence of one or more infection loci, development of clinical signs of multiple organ dysfunction (MOD), associated with infectious-inflammatory process, and an informed consent of parents to include their child into the research.
The research was carried out based on the results obtained from a retrospective analysis of 26 cases at maternity homes, and a prospective observation over a group of patients including infants transferred from maternity homes. The retrospective analysis assumed assessment of clinical-laboratory features of neonatal sepsis debut with an alternative term of the onset considering prognosis of development of cardiovascular lesions at the stage of further treatment at the neonatal department of Chernivtsi Regional Pediatric Clinical Hospital. The prospective study assumed a comparative analysis of neonatal sepsis course and/or involvement of cardiovascular disorders into multiple organ dysfunction. The group of comparison included 30 neonates similar to the representatives from the main group by their clinical signs but without infectious-inflammatory pathology.
Based on the results of clinical-epidemiological analysis, the most sensitive markers of sepsis-induced myocardial dysfunction are indicated in the study. They enable to diagnose myocardial dysfunction with the least amount of false-negative results: troponin more than 0,1 ng/ml (amount of false-negative results 20%), LDH more than 450 units/L (amount of false-negative results 15,2%). In verification of sepsis-induced myocardial dysfunction the most specific markers are the following: thrombocytopenia less than 100 g/L (amount of false-positive results 11,1%), procalcitonin more than 3 ng/ml (amount of false-positive results 14,8%), increased amplitude S in V1(amount of false-positive results – 18,5%), increased amplitude R in V6 (amount of false-positive results – 22,2%), and leukocyte index of intoxication more than 1,5 cu on the 3rd day of treatment (amount of false-positive results –20,4%). Therefore, by means of introducing available paraclinical markers into the routine medical practice of management of children with neonatal sepsis it is possible to find effectively involvement of the cardiovascular system into the process in order to correct it timely.
Irrespective of the initiated treatment in the main group of thy study with the diagnosis of neonatal sepsis, the period of septicemia followed by the development of multiple organ dysfunction, 4 neonates died at the age of 10, 13, 15 and 39 days. Histological examination of the postmortem material of one of these cases demonstrated hydropic dystrophy of the cardiac muscle cells, mucoid swelling in the interstitium, and fragmentation of the muscle fibers, which confirmed sepsis-induced myocardial dysfunction in neonates with the lethal outcome of neonatal sepsis, thus, additionally emphasized the importance and topicality of the subject of our research.
